The tooth is a structure of the oral cavity which is vital to the capability of chewing and important to the general well-being and appearance of people. Anatomically, the tooth resides within the oral cavity, firmly anchored within the upper and lower jaws (maxilla and mandible). Human teeth reside within two distinct anatomic regions of the jaws; the apical inferior portion of the tooth (the root) is connected to the jaw via an attachment called the periodontal ligament. This portion of the tooth that is connected to the bone can be defined as the “bone-zone” or hard tissue zone of the tooth. Second, the superior portion of the tooth (the anatomic crown) is connected to the jaw in the soft-tissue or gingival region of the jaw defined as the “tissue-zone” or soft tissue zone. The anatomic crown is demarcated as that portion of the tooth superior to the crest of bone and includes a small portion of the root superior to the crest of bone as well as the clinical crown that is visible. The tissue-zone forms a soft-tissue collar around the neck of a tooth. This tissue-zone connection (i.e. soft-tissue to tooth attachment) is composed of gingival fibers that insert into the superior aspect of the root surface; specifically, hemidesmosmal cell attachment to the root and crown forming a biological adhesion of the sulcular epithelium (gingival tissues) to the surface of a tooth.
The tissue-zone connection plays a critical role in maintaining health of the oral cavity. It does this by preventing the ingress of microbes and foreign substances into the body by providing a “biologic-seal” at the interface of the tooth-jaw connection at the tissue-zone. This functional attachment of the soft-tissue to the surface of the tooth should be fully appreciated as a critical defense barrier. As without the presence of this soft-tissue biologic seal the underlying bone would be vulnerable to numerous invasions of various foreign substances.
In addition, the tissue-zone plays an essential role in maintaining and preserving the dental esthetics of the smile. This same tissue-zone represents the peaks (papillae) and valleys of the soft-tissue gingival that surround the neck of each and every tooth. It is the spatial relationship of tooth form and color with healthy soft-tissue gingival architecture that are known as the essential building blocks of dental esthetics as we know it. Experts of dental esthetics have called the soft-tissue gingiva “the frame” of the picture, and regard the teeth as the “subject matter” of that painting. Disregarding the frame of a painting would certainly impact the overall esthetic appearance being viewed, and the same is true with respect to the gums and teeth. The loss or the alteration of anatomic structures of the tissue-zone has been shown to lead to an inferior esthetic outcome in addition to causing a potential risk of disease for the patient.
The tooth and its attachment to the jaw is subject to numerous pathogens over the lifetime of a patient, particularly due to trauma/fracture, endodontic failure, decay, localized periodontal disease, etc. Any of these conditions can lead to the eventual need for removal of either a single tooth or multiple teeth. The removal or extraction of a tooth or teeth will result in a radical morphologic change to the anatomy as well as the potential exposure of the internal tissues (connective tissues and underlying organs) of the body to invasion by foreign substances.
Loss of the biologic-seal of the tissue-zone also has a significant impact on soft-tissue changes to both the macro- and micro-anatomy of the gingiva. It is accepted in the dental literature that the loss of gingival attachment within the tissue-zone leads to the irreversible loss of the interdental papillae and the gingival architecture surrounding a tooth. Much effort has been directed toward preserving the bone after tooth removal but far less effort has been applied to preserving the macro- and micro-anatomy of the tissue-zone after tooth removal.
As will be explained more fully in the following, the method and arrangement of the present invention provide an effective means to preserve the esthetic and anatomic architecture of the tissue-zone after tooth removal and the immediate placement of a dental implant. In addition, the present invention simultaneously and effectively re-establishes the biologic-seal after tooth removal and immediate implant placement.
Immediate implant placement of a root-form dental implant has been shown to effectively osseointegrate. The residual gap that is present between the implant surface and the bone surface requires careful management whether a surgical flap is performed or a non-flapless minimally invasive extraction technique is used. In either of these two approaches, irreversible soft-tissue changes have been shown to occur with immediate implant placement after tooth removal. Changes within the tissue-zone are shown to occur as early as 2-3 days after the immediate implant placement.